Author, Expert & Speaker

A recurring theme of my posts is the vast scope and breadth of prison reform. The issues impact every aspect of human life. Prison is an insane world of forced routine accentuated by culture clashes, boredom, and the loss of personal freedoms. As such, real prison reform issues take time to percolate into a legislative forum that initiates change. One such issue struck me while writing a post on the federal First Step Act, signed into law on December 21, 2018, by Donald Trump.

In One First Step for Prison Reform—One Triumph for Human Empathy, I gave an overview of the five title sections comprising the new First Step Act. The third title has lingered with me: Restraints on Pregnant Prisoners Prohibited. I became curious about the origins and purpose of restraining prisoners during pregnancy, labor, and the aftercare of their infants. What societal threat was ameliorated by such restraints? And, most importantly, because state penal systems are not impacted by the First Step Act, do restraints on pregnant inmates continue today? And if so, why?

Background—Prison Culture

Prison rules and regulations often pop up in response to a singular incident. Reactionary rules lead to awkward and intrusive encroachments on freedoms. For example, because in 2001 Richard Reid attempted to blow up a flight from Paris to Miami by using an explosive device packed in his sneaker, we now have our shoes inspected when we go through airport security.

I saw this reactionary policymaking firsthand during my time in the California prison system. Imagination and paranoia manifest in rules such as inmates’ toilet bowls don’t have covers because a cover was once used as a lethal weapon. My research, however, has found no incident in which an inmate has ever caused harm to herself, attending doctors, prison officials, or her unborn child to substantiate restraints during pregnancy and while giving birth. So, what’s going on here? The answer is foggy and steeped in punitive acts by the government that are just now hitting the public’s radar.

Systemic cruelty to women inmates is part of our national heritage. In 2016, there were 220,000 women in our state and federal penal systems. A 2016 Johns Hopkins Medicine study called “Pregnancy in Prison Statistics (PIPS): Multi-Sector Research Collaboration” reported that in 1999 “6–10% of incarcerated women [were] pregnant” and that a 1998 survey reported 1,400 births a year. Another report from November 2017 says “experts predict that 1 in 25 female inmates in this country is pregnant, and that “over 2,000 children are born annually in prison.” These figures raise the question of whether jails and prisons are constructed to accommodate the healthcare issues presented by pregnant inmates.

A January 2, 2019, Los Angeles Times editorial, “L.A. County needs to Seriously Rethink the Mira Loma Women’s Jail,” gives us a reality check: women prisoners are housed in men’s quarters, which are not designed for women’s needs. “Women inmates simply need different quarters, designed for different needs and different programs, than men.” While the editorial does not mention pregnant inmates, it looks at women’s emotional attachments to their children and the internal drive to nurture. Many prisons are located in remote areas and where land values are comparatively low. The socioeconomic situation of inmates’ children can make it impossible for them to regularly visit their mothers, if at all. The editorial notes that transportation time between where children live and where their mothers are in jail can take up to two hours each way—and public transit isn’t an option.

The centerpiece statement of the editorial refers to the Los Angeles County Board of Supervisors (LACBS), which is now composed of four women supervisors and one man:

 [LACBS uses] an outmoded approach to a women’s jail, where 65% of inmates haven’t even been convicted of anything, where young mothers need visits from their kids during an especially stressful time, and where inmates who have been abused or terrorized by their male partners and who have turned to drugs for escape need regular face time with qualified clinicians and counselors on site—not video images broadcast from downtown L.A. because the commute is too onerous.

Pregnant Inmates

My only authority for advocating for humane treatment of pregnant inmates is my having witnessed the birth of my three sons. I was part of the process; I was an active prenatal support unit for the births, and from those experiences I cannot imagine the government restraining women during and after the birthing process. But the issues are much broader in scope.

The AMA (American Medical Association) Journal of Ethics, in a 2013 report entitled “Shackling and Separation: Motherhood in Prison,” includes a poignant description of a woman who gave birth while incarcerated to illustrate that the routine use of restraints on pregnant women, and particularly women in labor, is a cruel and unsafe practice:

“When they shackled me I had two handcuffs, one was on my wrist and the other one was attached to the bed. . . . My leg and my arm were attached to the bed so there was no way for me to move and to try and deal with the labor pains. And the metal, cause when you’re swollen, it would just cut into your skin. I had bruises after the fact that stood on me for three weeks. I mean, purple bruises from my ankle and my wrist from them having them shackles and handcuffs on me. Even when I had to get an epidural, they didn’t take the shackles and the handcuffs off. I just had to bend over and just pray that I could stay in that position while they were putting that needle in my back through the whole procedure. Not once did he [the correctional officer] try and loosen them. And the doctor asked him, you know, ‘Can’t you take them off of her? She can’t go nowhere. She can’t walk. She’s not goin’ nowhere.’ ‘It’s procedure and policy. Can’t do it.’”[1]

Other AMA Findings

The AMA report continues:

Shackling a woman by the ankles, wrists, and/or waist during pregnancy and delivery is not only unnecessary for security reasons, it is also medically hazardous and emotionally traumatizing. While shackled, pregnant women are at increased risk of falling and sustaining injury to themselves and their fetuses.[2] During labor and delivery, shackling interferes with a woman’s ability to assume various positions and prevents her immediate transport to the operating room if necessary.[3] Echoing these concerns, in 2011, the American College of Obstetricians and Gynecologists (ACOG) released a committee opinion concluding that “[p]hysical restraints have interfered with the ability of physicians to safely practice medicine by reducing their ability to assess and evaluate the physical condition of the mother and the fetus, and have similarly made the labor and delivery process more difficult than it needs to be; thus, overall putting the health and lives of the women and unborn children at risk.”[4]

The Harsh Realities of Being Pregnant in Prison

Alexandra Sakellariou’s eye-opening article, “15 Things That Happen When a Baby Is Born in Prison,” appeared in the November 2017 Babygaga newsletter and discusses the compounded challenges incarcerated pregnant women face. The article addresses aspects of confined pregnancy within the reality of penal systems that are not normally geared toward prenatal and postnatal care. Following are some of what can happen when a child is born in prison, (I encourage you to read all fifteen points listed in the newsletter.)

  • Pregnant women have been imprisoned for centuries. One of the earliest recorded stories of a pregnant woman being sentenced to prison happened in 1825—and it unsurprisingly didn’t have a happy ending. The pregnant inmate, named Rachel Welch, suffered a beating that was so severe it’s suspected to have caused both her and her infant’s death.
  • Having a baby can help mom change.

If she’s lucky, a mom can end up in the prison nursery (if there is one). As reported on the NBC News website on August 4, 2018, “In most [state] prisons, when a woman gives birth, her baby is taken away within 48 to 72 hours and sent to either a relative or foster care. Prison nursery supporters say that keeping newborns with their moms, even behind bars—while not a perfect solution—is better than any alternative.” This clip from the NBC report is a provocative look at women raising children in the Bedford Hills, New York, prison nursery—one of only eight prison nurseries in the United States.

  • Prison staff aren’t equipped to handle pregnant prisoners. “Prisons were designed with men in mind. Women are a small population; pregnant women are an even smaller one within that and many of the institutions haven’t really addressed the issue and the impact of current policies, [said] Naomi Delap, Director of pregnant prisoners activist group Birthing Companions. . . . “Prison staff and healthcare workers often don’t know what they should be doing. Some prison staff can be hugely supportive, but others don’t know what they’re doing.” 
  • Pregnant prisoners have a higher risk of PPD [postpartum depression]
  • . [This should come as no surprise.] Even once they get through the horrible experience of being pregnant in prison, they may have backlash to deal with after being separated from their babies. Other inmates may become jealous and believe the pregnant woman got special treatment, causing them to lash out, which only feeds the mom’s risk of having mental health problems. . . . Typically, a prison only allows the mom 24 hours with her baby before it’s placed in protective custody or given to a family member or friend on the outside.

Mothers behind Bars—A Report Card

A 2010 report by the Rebecca Project for Human Rights[5] graded state and federal treatment of pregnant women in prison in three categories. Grades from A to F were given for prenatal care, shackling mothers during labor and delivery, and family-based treatment as an alternative to incarceration. The report lists each state, its grades on the three categories, and a composite grade. Here’s a portion of the findings:           

These data suggest that a lot of work must be done with regard to the humane treatment of pregnant women in prison and the welfare of their children. We must stop acting punitively toward pregnant women and mothers in our penal systems. To quote from the AMA Journal of Ethics article, “As a historically male-focused institution, correctional facilities often fail to address the needs of incarcerated women. These needs include appropriate medical and [socialization opportunities for child visitation,] . . . reproductive health care, gender-specific substance abuse treatment, and counseling for histories of abuse, family services,” and the end to stripping this class of inmates of their human dignity during all aspects of motherhood.


The humane handling of pregnant women in prison and all the elements affecting the prenatal and postnatal well-being of mother and child present buckets of issues within the sea of prison reform matters that impact the everyday lives of incarcerated people. While the federal government has taken the right steps toward reform via the First Step Act, a majority of pregnant women and women with young children are incarcerated within the fifty states and the District of Columbia. Because states have the right to formulate their own policies for this category of inmate, the handling of issues relating to pregnancy in jails and prisons is a hodgepodge of conflicting regulations.

For more on this topic, see “Sexualized Conduct Toward Females Can Lead to Their Incarceration.”

“The degree of civilization in a society can be judged by entering its prisons.” Fyodor Dostoyevsky (1821–1881)

I always welcome your comments and observations.

Image courtesy of

[1] Diana Delgado, interview by Diana Delgado. Accessed August 1, 2013.

[2] Committee on Health Care for Underserved Women of American College Obstetricians and Gynecologists. “ACOG Committee Opinion No. 511: Health Care for Pregnant and Postpartum Incarcerated Women and Adolescent Females.” Obstetrics and Gynecology 118 no. 5 (November 2011):1198–1202.

[3] American College of Nurse-Midwives. Position statement: shackling/restraint of pregnant women who are incarcerated. Accessed August 1, 2013; American Civil Liberties Union. ACLU briefing paper: the shackling of pregnant women & girls in U.S prisons, jails & youth detention centers. Accessed August 1, 2013.

[4] Committee on Health Care.

[5] The Rebecca Project for Human Rights is a transformational organization that advocates protecting life, dignity and freedom for people in Africa and the United States.

Leave a Reply

Your email address will not be published. Required fields are marked *

This site uses Akismet to reduce spam. Learn how your comment data is processed.

Sign up below to receive Mark E. Roseman's blog each week!

Blog Categories

There was an error obtaining the Benchmark signup form. (401) Invalid/Missing AuthToken in request